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Main Risk Factors Of Colorectal Cancer

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Question:

What are the Risk factors of Colorectal Cancer? Analisys and Comparison in Risk Factors.
 
 

Answer:

Introduction  

The rising incidences of cancer worldwide have compelled the researchers to conduct enough researches and investigatory studies for the purpose of gaining adequate information and requisite knowledge pertaining to specific cancer types thwarting the lives of many. In this context colorectal cancer may be referred to that has been identified as a leading type of cancer affecting a large population globally. Uncontrolled proliferation of the cells in the colon and rectum accounts for the formation of timorous growths in these regions thereby causing colorectal cancer. Synonymously colorectal cancer is also denoted by the names of bowel cancer or rectal cancer or colon cancer. According to the data provided by the World Health Organization (WHO) and the centre for Disease Control and Prevention (CDC), colorectal cancer has been mentioned as the second most common type of cancer after lung cancer. The rates of incidences associated to colorectal cancer are more frequent in the developed nations compared to the developing countries. However, recent evidences suggest that the number is surging even in the developing countries with the chances being more high in case of the first generation migrants travelling from a less risky nation to a country with higher vulnerability (who.int, 2017). The malignant tumors in case of colorectal cancer may metastasize to other bodily parts and cause damage there. Signs and symptoms related to this clinical condition include pain in the abdomen, blood in stool and altered bowel habits that persist longer than a week (webmd.com, 2017). Therefore, a thorough understanding and insight into the matter pertinent to colorectal cancer is essential to get a glimpse of the risk factors that predisposes an individual of developing cancer and taking precautions congruent to the detected risk determinant. Unlike any other preventable diseases colorectal cancer posses certain modifiable as well non-modifiable risk factors. Non-modifiable risk factors encompass the issues related to older age, racial and ethnic status, personal history of colorectal polyps or colorectal cancer or inflammatory bowel disease or Crohn’s disease or ulcerative colitis, family history linked to adenomatous polyps or colorectal cancer, inherited syndromes and even chronic ailments like type 2 diabetes. On the other hand, the modifiable risk factors may be intimately related to the various lifestyle issues that normally include being overweight or obese, lack of physical activity, smoking habit, heavy alcohol consumption, intake of diets rich in calories, animal fats, saturated fats, and low in dietary fiber (www.webmd.com., 2016). Other lesser known risk factors that might influence the harbor of colorectal cancer include work in the night shifts for a considerable duration of time, previous exposures to treatments of other cancers such as testicular cancer, prostate cancer. Gender variation in the development of the disease often occurs in persons who are previously exposed to intervention modalities due to other cancer types. Thus the analysis of the epidemiological information concerning colorectal cancer will ensure reduced morbidity and mortality through adoption of suitable preventive strategies (Haggar & Boushey, 2009). Screening of familial and hereditary history in conjunction with the modulation of the environmental lifestyle related risk factors may thus benefit the persons affected by colorectal cancer.

Research Objectives

  • Identification of the range of risk factors associated to the development of colorectal cancer and detection of the vital one from them
  • Role of each of the detected risk factors in cancer prognosis
  • Understanding the relationship between each of the factors and recognition of the relative risk
  • Implementation of suitable preventive strategies based on the identifiable risk factors

Search and Review Strategy

Based on the objectives of the research, the methodology was structured in a manner that suits the purpose. A systemic review of literature was done utilizing the bibliographic databases including Google Scholar, PubMed and Science Direct for procuring the information from the peer reviewed journals and articles. Critical appraisal and careful scrutinizing of the facts in the sorted research articles was performed to retrieve the relevant data in compliance with the projected objectives. Secondary research methodology has the advantage over primary research in terms of providing quicker and cost effective technique to harness the desired outcomes. In view of the search strategy, keywords like risks and colorectal cancer together with a series of filters such as recent publications (last 10 years) were applied. Articles containing findings related to animal studies were excluded from the adopted search strategy.

 

Literature Review

Colorectal cancer has prominent and dynamic interactions with a multiple of factors that determine the course of the disease in the susceptible persons who are likely to be predisposed to the conditions necessary to trigger the biological pathways that ultimately leads to carcinogenicity. The most common identified factors in this respect encompass a wide variety, some of which are modifiable while the remaining ones are non-modifiable. Among the modifiable risk factors, lifestyle pattern associated with the practice of engaging in physical activity, alcohol consumption, smoking and the propensity to develop obesity along with other metabolic syndromes and diet are the chief ones. Moreover prior exposure to states of chronic diseases as well as carcinomas has been found to increase the likelihood of developing colorectal cancer. Certain liver diseases also predispose a person to harbor colorectal cancer. Further recent studies have revealed valid linkage between certain pathological conditions and colorectal cancer. Race, ethnicity and age also act as major determinants of colorectal etiology. Other factors such as working in the night shift are other potential reasons for the occurrence of colorectal cancer. Hence in this chapter, the factors associated will be discussed in details to provide a thorough insight into the matter pertaining to colorectal cancer.

Dietary Influence

In this respect diet plays a crucial role in which varied nutritional practices influence the occurrence of the disease (Song, Garrett & Chan, 2015). Dietary impacts on colorectal cancer have recently received much attention that stated the potential negative effects of the diet high in fat particularly of animal origin. Studies confirmed that increased consumption of red meat as well as processed meat accentuates the risk of developing the disease (Aykan, 2015). Red meat is linked to stronger association for rectal cancer while processed meat accounted for higher propensity towards distal colon cancer. The presence of heme iron in red meat accounts for the potential underlying mechanisms that acts as the etiologic factor for the development of the disease. Cooking procedures for meats like grilling, boiling or frying that utilize high temperature cooking causes the generation of certain carcinogenic chemicals like heterocyclic amines and polycyclic aromatic hydrocarbons that in turn increase the likelihood for colorectal cancer (Larsson & Wolk, 2006). Fat has also been suggested as a potential etiologic factor linking to the concept of Western diet that favors the growth of microbial flora that are sufficient to degrade the bile salts to potentially carcinogenic N-nitroso compounds (Bardou, Barkun & Martel, 2013). A contrast picture is cited in studies that state that the following of a Mediterranean diet comprising of ample amount of vegetables and olive oil but moderate amount of protein harbored positive benefits and outcomes in colorectal cancer risk assessment. The clinical manifestations are found to be more prominent in women rather than men. Further studies imply that dietary fibers may positively influence colorectal cancer by means of diluting the fecal content, increasing fecal bulk and reducing transit time (Bamia et al., 20.13).

Studies relevant to the dietary regime in the patients suffering from colorectal cancer clearly indicate that it plays a pivotal role in the disease prognosis. Diet high in saturated fats, animal protein, calories seems to negatively impact the risk related to colorectal cancer. The cytoprotective action of certain prebiotics and probiotics were suggested in certain studies. Synbiotic intervention caused significant alterations in fecal flora. Colorectal cancer biomarkers were modulated favorably by man of symbiotic intervention. Clostridium perfringens decreased while Lactobacillus and Bifidobacterium increased concomitantly. In case of the polypectomized patients, declining levels of colorectal proliferation supported by the necrosis in the colorectal cells through fecal water and improved barrier function of the epithelial barrier. At the end of the intervention period, a reduced exposure to genotoxins was noted in genotoxicity assays of colonic biopsy. γ interferon expression was increased in cancer cells while peripheral blood mononuclear cells caused increased secretion of interleukin 2 by virtue of prevention offered through symbiotic consumption (Rafter et al., 2007). Further studies relevant to nutritional supplements and necessary nutrients provided by vegetables and fruits indicate the relative efficacy of the phytochemicals (Li et al., 2015). In this context epidemiological studies concerning the cruciferous vegetables like cabbage, cauliflower, broccoli, brussels sprouts and other green leafy vegetable of similar kinds were revealed to exhibit potential roles in lowering the risk of colorectal cancer. Cruciferous vegetables are found to be rich sources of glucosinolates, and their hydrolysis products consisting of the isothiocyanates and indoles offer protective actions against possible cancer. However, the individual genetic polymorphism in metabolism and elimination of the isothiocyanates from the body may affect the protective effects. Bioavailability coupled with intake of glucosinates in addition to its derivatives is also affected by the cooking procedures (Higdon et al., 2007). In humans the chemoprevention role is achievable by the enhanced absorption of anthocyanins and their derivatives. The most important, abundant and indispensable flavonoid constituent of fruits and vegetables are the anthocyanins that contribute towards cancer prevention in humans (Wang & Stoner, 2008). In view of the findings that encourage healthy eating through increased consumption of fruits and vegetables, the roles of vitamins and minerals that are present in them are explicitly defined. The role of vitamin C has been found to have beneficial effect in combating the negative impacts of colorectal cancer. Empirical researches provide evidence that further protection is conferred upon abundant intake of food rich in folates against development of colorectal cancer (Cho et al., 2015). A number of intrinsic and extrinsic modifiers are responsible for defining the relationship between the folate exposure and risk for colorectal cancer. Intake of other three B vitamins in combination with the folate therapy accounts for the effective operation of the 1 carbon pathway and synthesis of the nucleotides. The Wnt signaling pathway cascade is the identified mechanism that support for the cancer protective action. Ongoing researches have also taken into careful consideration whether excessive intakes of intake by the parents have any paradoxical cancer promoting impact on the consecutive generation offspring (Mason, 2016). Therefore recommendations for healthy eating comprising of diets rich in vegetables, fruits and whole grains are made to fight the nuances of colorectal cancer.

 

Lifestyle Factors

The changing patterns of lifestyle mostly of sedentary types, in today’s modern world also act as a major contributor for increasing the risk for colorectal cancer in certain vulnerable population. Recent researches have focused on regulating factors of lifestyle that directly or indirectly affect the colorectal cancer prognosis (Durko & Malecka-Panas, 2014). Age and educational level have been revealed to affect the awareness of lifestyle factors related to colorectal cancer. Results have suggested that initiatives are desirable for the vulnerable population of young people who are likely to benefit most out of declining levels of risk. The findings of relevant study suggest that most of the people were unaware about the cure pertinent to colorectal cancer if diagnosis is done early. Knowledge concerning the dietary planning was found to be better with respect to risks related to weight and physical activity. Further studies suggest that lower educational level was intimately linked to poor awareness regarding the screening and preventive strategies of colorectal cancer (Siegel, DeSantis & Jemal, 2014). Hence, screening promotion should aim to foster awareness among the public at large particularly among those above the age of 50 years who are more prone to harbor colorectal cancer (Lynes et al., 2016). Several modifiable lifestyle risk factors particularly of smoking and alcohol are linked to the development of serrated polyps (Shrubsole et al., 2008). The identifiable risk factors that relate to the risk of colorectal cancer encompass alcohol, smoking, body fatness, physical activity, diet, medication and hormone replacement therapy. Significant increase in risk for serrated polyp as occurring in cases of colorectal cancer include the associations of several risk factors including alcohol consumption, tobacco smoking, body mass index and high intake of meat or fat. Direct linking between smoking and alcohol but not body fat accounted to be stronger in case of sessile serrated adenomas compared to the hyperplastic polyps. Contrarily, decreased risk for serrated polyp includes factors related to the use of the non-steroidal anti inflammatory drugs or aspirin, in combination with high intake of calcium, folate or calcium. Risk of serrated polyp did not show any significant relation between physical activity and hormone replacement therapy (Bailie, Loughrey & Coleman, 2016). Another study relevant to the Canadian population of 15-49 years critically analyzed the trends in modifiable risk factors related to colorectal cancer. The results of the study brought to the forefront that excess weight is prevalent among the young adults. Therefore, excess weight has been detected as a possible factor contributing to the rising incidence of colorectal cancer. Moreover, the rising trend in increasing weight among the younger generations in the Canadian population seems to impact the risk status for colorectal cancer (Patel & De, 2016). Further studies have supported that genetic factors and lifestyle are intimately associated to the development of colorectal cancer. Increased risk of colorectal cancer was found in cases of methylenetetrahydrofolate (MTHFR) polymorphism, 5? UTR repeat polymorphism. LL genotype was found to be more frequent in case of people suffering from colorectal cancer. Further, alcohol has been also found to be significantly associated with the risk for harboring colorectal cancer (Baroudi & Benammar-elgaaied, 2016). Another study concerning the New Zealand population also combined the various aspects of lifestyle that lead to colorectal cancer. In this regard, several risk factors have been identified that evaluated and estimated the effect of reducing the exposure relating to the identifiable risk factors. Lower risk for developing bowel cancer has been attributed to the reduction in obesity, smoking, alcohol intake and consumption of processed and red meat along with simultaneous increase in physical activity (Richardson et al., 2016). A sedentary lifestyle in combination to a number of possible factors accounts for the pathogenesis of colorectal cancer in persons who are affected by the condition.

Inflammatory Condition and Pathologic Diseases

There have been wide speculations relating to the chronic inflammatory state that might be a major contributing factor to the genesis of cancer pathogenesis. Prior exposure to other diseases or carcinomas predisposes a person to exhibit the symptoms associated to colorectal cancer. Patients with previous history of ulcerative colitis are much more vulnerable to encounter conditions relating to colorectal cancer. Moreover, personal history of colorectal polyp or colorectal cancer also contributes to making a person more prone to encounter conditions of colorectal cancer (Imperiale et al., 2014). Findings revealed that Crohn’s disease characterized by chronic inflammation state that poses as a vital risk factor for colorectal carcinoma. The state of chronic inflammation creates a suitable microenvironment ideal for the onset and progression of carcinogenesis pertaining to colorectal cancer. A proinflammatory state along with chronic states of inflammation thus pave the way for creating environments convenient for the growth of the cancer cells (dos Santos & Barbosa, 2016). Another study suggests obesity and diabetes as the prognostic factors affecting the development of colorectal cancer, one of the most common types of carcinoma in both men and women (Ma et al., 2013). Obesity is a crucial risk factor that has the capacity of expressing inflammatory markers, a major determinant of this metabolic syndrome. Further it has been implied through prospective studies that type 2 diabetes (non-insulin dependent diabetes) has the potential of increasing the likelihood of occurrences for colorectal cancer. Type 2 diabetes and colorectal cancer share common risk factor such as obesity or being overweight. Analysis of the risk factors provide evidence that type 2 diabetes has an increased risk of harboring the colorectal cancer symptoms in addition to having less favorable prognosis for the disease. Hence prognostic indications for colorectal cancer are provided by virtue of metabolic syndromes like diabetes and obesity where marked changes in the body’ responses to inflammation and associated events are prominent (Voutsadakis, 2016). Studies relevant to the assessment of outcomes in patients affected by ulcerative colitis with low grade dysplasia indicate the rapid progression of the symptoms in these patients towards colorectal cancer undergoing surveillance. The risk of harboring colorectal cancer increased manifolds in patients who are suffering from low grade dysplasia like condition (Fumery et al., 2016). Another counter study reveals that patients with colorectal cancer are at an increased risk of developing conditions associated with venous thromboembolism, heart disease, stroke and myelodysplastic syndrome (Bianconi et al., 2015). Utilizations of the erythropoietic stimulating agents accounted for significant increased association between the proportionate rises in the risk for myelodysplastic syndrome in patients encountering colorectal cancer related symptoms (Du & Zhang, 2015). Further epidemiological studies relevant to colorectal cancer corroborate with the findings from past studies and showed that the modifiable risk factors such as that of diet and lifestyle issues have the potential of transforming the scenario through proper awareness and disease mitigation strategies (Kim, 2009).

Pathologies and Colorectal Cancer Risk

Further analysis of studies relevant to the risk factors pertaining to colorectal cancer brought to the forefront the associations and propensity of various diseases. Risk of colorectal cancer was documented in cases of chronic liver diseases subjected to before and after liver transplantations (Komaki, Komaki & Sakuraba, 2016). In general obesity and metabolic syndrome are found to increase the likelihood of cancer. In addition to this, liver diseases especially of the non-alcoholic fatty liver disease have been found to be closely associated with colorectal cancer.  Another exploratory study concerning the association between Parkinsonism and colorectal cancer has been linked to the risk of the disease. In the Western population, patients suffering from the neurodegenerative disease of Parkinson’s disease were significantly related to the decreased risk of developing colorectal cancer. Similar studies in the Asian context, needs to be further explored to get an idea of the association. The inverse relation between Parkinsonism and colorectal cancer needs to be further assessed to confirm the study findings (Xie, Luo & Xie, 2016). Hence a deeper probe into the reduced risk associated with the non-melanoma cancer in Parkinson’s disease must be reconfirmed through further epidemiological studies. Subsequent studies provide evidence providing the distinctions between sessile serrated adenomas, traditional serrated adenomas compared to the hyperplastic polyps. Both sessile as well as traditional serrated adenomas are identified as the identifiable precursors to colorectal cancer. Results of the studies exposed the increased risk of colorectal cancer in patients with sessile serrated adenomas or traditional serrated adenomas. The level of risk was found to be similar or higher compared to the presence of conventional adenomas in the concerned patients (Erichsen et al., 2016). Thus the clinical relevance of the advanced adenomas must be carefully recognized and treated accordingly since most colorectal cancers are found to develop from adenomas. Further accounting to the inverse association of the adenoma detection rate with the risks of developing colorectal cancer, timely diagnosis and intervention may yield positive outcomes through mitigation of the risk factors.

 

Age

Another study examined the risk factors associated with the development of colorectal neoplasia in individuals below the age of 50 years. Evaluation of the risk factors for colorectal cancer was studied extensively in case of population belonging to the age group of 30-39 years and others. A thorough cross-sectional observational investigation of the risk factors for colorectal neoplasia in conjunction with comparison between persons belonging to varied age group ranges was conducted. The adult cohort groups selected for the study comprised of populations belonging to the age group of 30-39 years, 40-49 years and 50-59 years. Findings revealed that for the 30-39 years group, male gender, fatty liver, smoking, obesity, metabolic syndrome, elevated triglycerides level and elevated fasting blood glucose levels were linked to overall neoplasia. Final interpretation of the study suggests obese male smokers with fatty liver and metabolic syndrome might harbor benefits from screening below the age of 50 years (Jung et al., 2015). Therefore as per empirical research findings, the risk of getting colorectal cancer is found to increase with age and the risk is even more in men than in women. As a person tend to get older the likelihood of harboring colorectal cancer increases manifolds. However colorectal cancer has also been found to occur among teenagers as well as young adults, but more than 90% of colorectal cancer happens in persons older than 50 years. Thus, persons attaining old age must undergo screening from time to time to allay the possibility of harboring the disease and reduce the risk legitimately.

Familial history, Race and Ethnicity

Race and ethnicity has also been suggested as crucial factors that determine the course and relative increased rates of occurrence of colorectal cancer pathogenesis in certain population with respect to other vulnerable groups. In the United States, the Afro-Americans were found to be affected more by colorectal cancer incidence and mortality rates. Even the Jews having the Eastern European descent, possess the relative higher risks for colorectal cancer compared to any other ethnic groups in the world. The causes for such disproportionate distribution of relative propensity to the development of colorectal cancer have been attributed to various genetic mutations (cancer.org, 2017). In this regard, novel recommendations pertaining to inflammatory bowel disease related to the screening and surveillance in case of the moderate and high risk populations. The recommendations include the guidelines for the frequency of screenings for people at higher risk and those at moderate risk of harboring the disease due to familial history of colorectal cancer. Accordingly, case appropriate techniques and methods are suggested for the vulnerable populations (Cairns et al., 2010). More studies concerning the colorectal cancer constitute screening protocol to determine the relative risk in the concerned groups in an effort to mitigate the rates of colorectal cancer incidences and mortality rates. Study has recommended the utilization of flexible sigmoidoscopy as a safe and practice test applicable for the age group between 55-64 years to offer substantial and long term benefits (Atkin et al., 2010). Based on extensive research based evidences related to colorectal cancer screening and surveillance has outlined specific and updated guidelines to counteract the effects of colorectal cancer thereby allowing provisions for prevention of further recurrences. Estimation of the relative risks associated to each of the techniques necessary to carry out the screening procedures in addition to the evaluation of the inconveniences, and cost of every approach were considered. In this regard, suggestions supported by proper evidences have acknowledged the use of novel screening tests such as virtual colonoscopy and tests concerning altered DNA in stool to effectively diagnose and screen patients for colorectal cancer. Alongside the screening programs, recommendations encompassing several paraphernalia and issues including the patient’s attitudes, insurance coverage, physician’s behaviors apart from the surveillances and reminder systems have been made to combat the effects of colorectal cancer (Winawer et al., 2003). In a study pertinent to the racially and ethnically diverse population of Texas, associations between the contextual factors and colorectal cancer were assessed. The study provided evidence that individual characteristics impacted the differential responses for colorectal cancer screening in patients. Population thriving in localities having gory employment rates exhibited negative influence on screening attitudes. A major determinant of health was offered by the neighborhood socio economic disadvantage (Calo et al., 2015).

Working in Night Shift and other Surgery or Non-Surgery related risk factor

In addition to the dietary pattern alteration, lifestyle related risk factors and familial history of colorectal cancer, other risk factors that relate to the development of the disease include some of the less understood and relatively less explored effects of some aspects. One such less examined aspect considered the associations between night shift working and risk of harboring colorectal cancer. As per the findings of the nurse’s health study, the risk of developing colorectal cancer, particularly in women increases many folds by working a rotating night shift for at least three nights per month for 15 or more years. The reason has been attributed to the decreased production of melatonin at night time due to exposure to light that has been identified as the anti proliferative effects relevant to the case of intestinal cancers (Schernhammer et al., 2003). An interesting insight into the matter related to colorectal cancer focuses on the complications arising due to colorectal anastomotic leakage following an intraoperative intestinal surgery. The outcomes of the study confer a vivid idea regarding improvement of colorectal care following modification of both surgery related as well as non-surgery related risk factors (van Rooijen et al., 2016). A study aimed to identify the risk factors linked to advanced adenoma and colorectal cancer, resorted to a population based colorectal cancer colonoscopy screening program. It was found by means of this investigation that elderly screening participants, subjects with lower intake of calcium, ones having a familial history of colorectal cancer, as well as the smokers are at a relatively higher risk of presenting detectable advanced colorectal neoplasia at screening colonoscopy (Stegeman et al., 2013). Another study evaluated the linkage between expanded health belief model factors and colorectal cancer screening. The factors associated with screening included self efficacy, stage of readiness and discussion with providers. The findings of the study predicted the outcomes in patients who are likely to engage in colorectal cancer screening. However, knowledge and barriers were not independently associated with screening (Sohler, Jerant & Franks, 2015). The study relevant to associations between colorectal cancer occurrences after colonoscopy that did not show the diagnosis of colorectal cancer based on hospital based statistics. Post colonoscopy colorectal cancer was found to be intricately related to female gender, older age, elective procedures, rising comorbidity, colorectal cancer on the right side of the colon, and colonoscopy volume. Post colonoscopy colon cancer was linked to worse outcomes (Cheung et al., 2016). Cancer recurrence was evaluated by virtue of a retrospective study. The findings suggest that the patients who underwent endoscopic resection for T1 colorectal cancer alongside those having tumors with only submucosal invasion were found to be at low risk for cancer recurrence (Yoshiii et al., 2014). Therefore, more research and insight regarding the unexplored and less known matters related to colorectal cancer need to be done in order to make the people aware about the harmful effects of the clinical condition.

 


Assessment of risks for colorectal cancer may be done through a number of ways as depicted in relevant research studies. A study conducted among the university students in Jordan evaluated the knowledge and awareness pertaining to colorectal cancer encompassing early warning signs and risk factors involved. The investigation revealed that abdominal pain was the most prominent and detectable warning sign for colorectal cancer among the respondents. Moreover, awareness related to the risk factors for colorectal cancer was found to be lowered compared to awareness regarding the warning signs awareness. Female population were found to be more aware about the symptoms related to colorectal cancer and unhealthy diet was recognized to be a potential risk factor for colorectal cancer among the respondents. Students engaged to studying medical related specialities were found to be more aware about the risk and associated warning signs for colorectal cancer. Continuous education programs, lectures or campaigns are thus desirable to promote early detection of colorectal cancer (Mhaidat et al., 2016). An exploratory study aimed to determine the risk factors of stenosis that occurs after endoscopic submucosal dissection that enables en bloc removal of large colorectal neoplasms. Post colorectal endoscopic submucosal dissection, circumferential mucosal defect above 90% poses significant risk factor of stenosis (Hayashi et al., 2016).  Another study brought to the forefront increased risk of colorectal cancer for women subjected to hysterectomy or oophorectomy. Generally women having susceptible genes for ovarian cancer or metacarcinoma undergo hysterectomy or oophorectomy and the associations between the performed operations with increased morbidity of colorectal cancer have been found as important indicator for public health guidelines (Luo et al., 2016). Further a review study focused on the current knowledge pertaining to colorectal cancer in view of the common molecular modifications through effective interactions between different environmental and non-environmental factors. The most potential treatment interventions are thereby discussed in keeping with the identified altered pathways. Somatic mutations in response to environmental factors have been implicated as the major reason behind the non-hereditary causes for the development of colorectal cancer. Hence preventive and combat strategies are improvised likewise to assess the efficacy of the efficacy of the identified causative factors (Aran et al., 2016). Recent researches have highlighted the utilization and incorporation of non-genetic risk factors in addition to behavioral modifications to predict risks associated with colorectal cancer. Modeling of lifestyle factors ranging from alcohol consumption in conjunction with genetic risk is capable of offering beneficial techniques to select persons for screening of colorectal cancer risk (Yarnall, Crouch & Lewis, 2013). The risk of colorectal cancer related to the inflammatory biomarkers, aspirin usage has been explored by means of the physician health’s study based evidences. The findings indicated that among men population, the plasma inflammatory markers such as CRP, IL-6 and TNFR-2 were found to be not significantly related with colorectal cancer although a statistically non-significant positive relation between TNFR-2 and subsequent risk for colorectal cancer was evident in the studied group (Kim et al., 2016). Hence, the provisions for care and preventive techniques associated with the risk of colorectal cancer need to be carefully analyzed to render effective and appropriate treatment intervention.

The clinical condition of colorectal cancer is a multi faceted disorder that seems to be affected by means of several independent risk factors that in turn affect the progression and outcomes of the disease. The risk factors associated with colorectal cancer comprise of numerous factors that may be either modified or cannot be modified. The modifiable risk factors are mostly associated with lifestyle orientation in an individual. In this context, dietary pattern are found to play an important role in predisposing a person towards the development of colorectal cancer. A diet high in saturated fats, animal protein and processed meat are likely to be at a higher risk of colorectal cancer. Further studies provide evidence that lack of enough micronutrients like calcium in food supported by less presence of dietary fiber also account for increased risk of colorectal cancer. Smoking habits as well as habit of alcohol intake in excess also increase the likelihood of developing colorectal cancer. Therefore following of a healthy diet comprising of sufficient amount of fruits, vegetables and whole grains is highly recommendable to combat the risks associated with colorectal cancer. Further cancer likelihood increases by means of faulty cooking procedures like frying, grilling and others at high temperatures that lead to the generation of carcinogenic chemicals. Chronic state of low grade inflammations as evident in conditions pertaining to obesity also poses threat of developing colorectal cancer. In both men and women, being overweight poses similar risk factors for colorectal cancer. Further study has indicated that persons who are accustomed to leading sedentary life and having lack of physical activity in their routine lives are more vulnerable to harbor colorectal cancer symptoms. Thus prescription of adequate physical exercise in daily lives might help in reducing the risk of colorectal cancer. Moreover effective lifestyle modifications may be achieved by one through shunning of the smoking habit and reducing the consumption of alcohol which in turn account for declined risk for colorectal carcinoma. On the other hand the non-modifiable risk factors that increase the likelihood of developing colorectal cancer encompass a multiple issues ranging from age, race and ethnicity, personal history of chronic diseases or colorectal cancer, familial history of colorectal cancer or adenomatous polyps in addition to type 2 diabetes. Personal history of colorectal cancer in conjunction with other diseases such as Crohn’s disease, ulcerative colitis, irritable bowel disease, dysplsia also account for increased risk for colorectal cancer. Previous exposure to colorectal cancer also increases the propensity for the concerned disease. As per research, inherited syndromes like familial adenomatous polyposis (FAP), gardner syndrome, Turncot syndrome, Lynch syndrome also increase the risk of colorectal carcinoma in individuals having familial history of the disease. In males, testicular cancer as well as prostate cancer also accentuates the likelihood of the disease while in female hysterectomy or oopherectomy account for similar outcomes. Empirical research findings also revealed night shift work as a potential cause for colorectal cancer. Thus assessing from the results of the research findings through extensive literature review it may be suggested that following of a healthy and productive life in combination with proper dietary regime, adequate exercise intervention as well as elimination of smoking and alcohol drinking habits might harbor positive outcomes in persons who are at the risk of developing colorectal cancer. However the non-modifiable risk factors can only be kept at bay through proper screening and adopting appropriate strategies to combat the effects. Thus the need for a proper screening and surveillance strategy to cater to the needs and demands of the patients has been suggested by the appropriate regulatory authorities to address the various issues relevant to colorectal cancer.

 

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